My paper this week was A random crossover study of bee sting therapy for multiple sclerosis which can be found at: http://www.ncbi.nlm.nih.gov/pubmed/16221950. The purpose of this study was to use a clinical experiment
to investigate the effectiveness of bee sting therapy for patients with
Multiple Sclerosis. Bee sting therapy was used to treat patients with MS
because of the belief that it could stabilize or prevent progression of the
disease. The researchers randomly assigned 26 patients with MS to receive 24
weeks of bee sting therapy or 24 weeks without treatment, and then switch to
the other treatment. Researchers looked at gadolinium-enhancing regions, which
indicate blood brain barrier permeability and inflammation, on T1-weighted
brain MRI. In both groups, after the treatment, researchers found no decrease
in these gadolinium-enhancing lesions. Furthermore, they found that the
T2*-weighted (a different type of MRI contrast) lesions progressed, and there
was no decrease in relapse rate, fatigue, disability or improved quality of
life. This study showed the ineffectiveness of bee sting therapy in treating MS.
There are four types of MS. The first, relapsing-remitting
MS is marked by periods of relapse with flare-ups, and remission, or recovery.
About 80% of people with MS start out with this type. The second form is called
secondary-progressive MS, where relapses and partial recoveries occur, but the
disability does not fade in times of remission. In primary-progressive MS,
there are no periods of remission and the disease progressively worsens from
the onset. The last type, progressive-relapsing MS, is characterized by periods
of remission which contain steadily worse attacks and symptoms. In this study,
patients with relapsing-remitting and secondary-progressive MS were studied to
investigate the effect of bee sting therapy on relapse rate, among other
variables.
Bee sting therapy is used because of the unique properties
of honeybee venom, like the anti-inflammatory agents melittin, a small peptide
known for its lytic properties, and adolapin, a polypeptide that can inhibit
cyclooxygenase. The venom also contains apamin, which is a polypeptidee which
can cross the blood brain barrier and regulate neuronal activity by blocking
the after-hyperpolarization potential of neurons.
Although this treatment was ineffective, the authors of the
study did mention a few other treatments that looked promising. I did some
research on the treatments to see their effectiveness and their viability.
Interferon beta is treatment to reduce frequency of
exacerbations in patients with relapsing-remitting MS. The bee sting article
gives this as a promising treatment, saying that a reduction of 50-80% in new
MRI activity has been shown with interferon beta treatment. Although the
mechanism is unclear of how interferon beta interacts with the disease, it does
block interferon gamma, which is proinflammatory in MS. However, recent research shows it does not
help slow the progression of the disease. A lay article describing a study
about this in the Journal of the American Medical Association can be found at: http://www.cbsnews.com/8301-504763_162-57475123-10391704/commonly-prescribed-interferon-beta-does-not-delay-multiple-sclerosis-progression-in-study/.
Interferon beta also has some severe side effects, such as severe depression,
allergies, liver problems, seizures, and changes in blood composition.
Another drug that this study suggests is effective for
reducing new MRI activity up to 90% is natalizumab, a monoclonal antibody
against cell adhesion molecule alpha-4-integrin. It is designed to stop immune
cells from migrating across the blood brain barrier into the brain. Studies
have shown that natalizumab reduced exacerbations and lowered risk of disease
progression compared to placebo. However, this drug increases the risk for
progressive multifocal leukoencephalopathy, which currently has no cure and
typically results in death, so it is advised only when no other treatment is
working. Natalizumab can also increase risk of infection and has been found to
increase risk of liver damage, even after only one dose.
Like we discussed in class last week, the treatments for MS
are typically ineffective, like the bee sting therapy, or filled with
detrimental side effects that could possibly outweigh the benefits of taking
them. More research is desperately needed in this area to find an effective and
safe treatment and cure.
www.nationalmssociety.org
http://www.mayoclinic.org/multiple-sclerosis/types.html
Julia, I'm glad you did some more research on the other treatments mentioned in the paper. I found them very interesting, but also discouraging since the side effects are so detrimental, such as the liver damage that can result from just one dose of natalizumab.
ReplyDeleteI liked reading this bee sting article because it reminded me of when "bee sting therapy" was a fad way back in the day for treating things like arthritis. It seems like a promising treatment when considering the anti-inflammatory properties of the bee venom, so it is unfortunate that it did not prove to be successful in MS patients. (I feel especially bad for the people in the study because they went through all that stinging for no positive results!). Perhaps it might be possible to isolate just the anti-inflammatory properties of the bee venom as to avoid the other neurotoxic effects and create a drug out of this which would also avoid the painful administration of a bee sting.